Pyrroluria - Vitamin B6 and Zinc Deficiency
Paula first came to see me three years ago. At that time she was feeling distraught and miserable as she had lost three pregnancies during her 20s and was keen to be a mother. Paula is now 33 and 16 weeks pregnant.
Paula's health history proved to be complex. As well as experiencing three miscarriages between 8-10 weeks of pregnancy, she had a tendency towards feeling depressed, had periods that came only every 6-12 weeks and she felt quite nauseous most mornings.
During her early teens she had suffered with anorexia and today she remains calorie conscious. Paula is 5' 6" tall and weighed around 8 stone when I first saw her. Although never having been overweight, she had been plagued by stretch marks since her early teens and almost constantly had white marks on her fingernails. Indigestion, flatulence and feeling bloated were everyday experiences that she had learnt to live with.
Her parents were both prone to depression. She has two sisters, one who suffers with schizophrenia and a younger sister who tends towards depression. Her wider family history indicated that mood disorder was apparent among her ancestors, though little formal knowledge was known.
Paula's presenting diet confirmed that her calorie intake was low and that her food choices were narrow, albeit generally within a healthy range. She would eat 1-2 slices of white toast and sugar free jam for breakfast every morning. Her feelings of nausea made it difficult for her to eat much at breakfast time. At lunchtime she would invariably have a tin of good quality vegetable soup with a baguette and scraping of butter. Her evening meal was a small portion of chicken or fish with two vegetables. Paula did not eat red meat. On most days she would snack on two bananas. She drank around a litre of bottled or filtered water every day and a couple of glasses of pineapple juice. She did not drink alcohol. Occasionally she drank tea or coffee and rarely ate confectionery or savoury sauces or snacks.
My clinical judgement was that a deficiency of zinc and vitamin B6 were central to the symptoms that Paula presented with. However, given her low calorie intake and symptoms of digestive disturbance which could affect her absorption capacity, it was likely that she had widespread nutrient deficiencies. To confirm my suspicions I recommended that she had a blood test to confirm her vitamin and mineral status and a urine test to measure her absorption capacity.
I also recommended that she had a urine test to check for an excessive presence of kryptopyrroles, which have the ability to bind to vitamin B6 and then attach zinc to the complex causing an excess loss of these two vital nutrients into the urine. An excess production of kryptopyrroles has been shown by some researchers to be stress induced and to run in families. This problem has been given the name Pyrroluria by the Brain Bio Centre in New Jersey and is associated with depression and schizophrenia. Pyrroluria is not a recognized biochemical abnormality by the orthodox psychiatric community. However, clinically I find this concept useful and testing for the level of kryptopyrroles in the urine a helpful diagnostic aid to support a deficiency of zinc and vitamin B6.
Zinc and vitamin B6 are critical nutrients for brain function, fertility, regulation of the menstrual cycle, maintenance of pregnancy and for the production of digestive enzymes. In addition, zinc is needed for producing stomach acid that helps to break down protein. Zinc deficiency is associated with white marks on the fingernails and stretch marks.
Researchers at the Brain Bio Centre found that sufferers of Pyrroluria did better on a low protein diet. Perhaps this was why Paula's diet was relatively low in protein with just a small portion of chicken or fish each day and why she could only eat toast and jam for breakfast. Nausea, flatulence and bloating can be the result of inadequate digestion of protein. I also recommended that Paula underwent a relatively simple test to check for the production of stomach acid and digestive enzymes.
However, adequate protein is critical during pregnancy for the growth and development of the baby. Similarly, Paula needed protein for building her own body tissue and a lack of dietary protein may partly explain her being light for her height. Red meat is a rich source of protein and zinc and on further questioning Paula indicated that she had stopped eating red meat when she was 12. Zinc is essential for the mechanism of taste and smell and the symptoms of zinc deficiency closely relate to the symptoms of anorexia. Paula started her periods when she was 14 and they had always been irregular. Her feelings of depression seemed to start when she was 15.
Researchers at the Brain Bio Centre have found that Pyrroluria often starts in teenage years and is more common in females. They also found that a history of miscarriage can be common and that it was more likely for a male infant to be miscarried as the development of the male reproductive organs require more zinc. Amino acids, the breakdown products of protein are also needed for the production of mood-regulating chemicals called neurotransmitters.
For neurotransmitters to function properly the brain needs an adequate supply of important fatty acids. Substantial research is emerging in support of a lack of these important fatty acids as a cause of depression and schizophrenia. Paula mostly ate chicken and ate fish only once a week or less. She didn't eat wholegrains or nuts and seeds and, due to her calorie consciousness, avoided extra oils. All of these foods are good sources of these important essential fatty acids.
I discussed with Paula the desirability of her delaying becoming pregnant again whilst awaiting test results and, depending on the results, working with her to correct any deficiencies and/or biochemical abnormalities. She was keen to comply with this recommendation and was very interested and motivated by the connections that I had made with her symptoms and family history.
Her results confirmed low stomach acidity, poor production of digestive enzymes, poor absorption, kryptopyrrole levels significantly above the reference range and a variety of other vitamin and mineral deficiencies.
Gradually over the next two years, with tailored nutritional support, Paula's profile normalized and she conceived successfully. She has succeeded in passing ten weeks of pregnancy and all appears normal at the moment.
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